不同时间点中性粒细胞/淋巴细胞比率与老年髋部骨折患者术后死亡率和并发症的相关性研究

Relationship between Neutrophil to Lymphocyte Ratio at Different Time Points and Postoperative Mortality and Complications in Older Patients with Hip Fracture

目的探讨不同时间点中性粒细胞/淋巴细胞比率(NLR)与老年髋部骨折患者术后死亡率和并发症发生率的相关性。方法选取南方医科大学顺德医院2013年1月~2017年12月老年髋部骨折手术患者217例,收集术前、术后1 d及术后7 d的中性粒细胞/淋巴细胞比率,随访1年死亡率及术后并发症发生率,对无并发症组与并发症组及生存组与死亡组不同时间点NLR值进行统计学分析。结果无并发症组和并发症组术前、术后1 d、术后7 d NLR值比较,差异均有统计学意义(P<0.01);术后7 d ROC曲线下面积为0.87,最佳分割点为NLR=4.72,多因素logistic回归分析显示术后7 d NLR>4.72是发生并发症的独立危险因素(P<0.001)。生存组和死亡组术前、术后1 d、术后7 d NLR值比较,差异均有统计学意义(P<0.01)。生存组术后NLR下降迅速,死亡组无明显变化,ROC曲线下面积为0.79,最佳分割点NLR=4.78。采用Kaplan-Meier法评估生存率,术后7 d NLR>4.78的患者生存率较低(P<0.001)。结论在老年髋部骨折患者中,术后7 d NLR>4.72是术后并发症的危险因素,术后7 d NLR>4.78与术后1年生存率相关,应重视其临床意义。

Objective To investigate the relationship between neutrophil to lymphocyte ratio(NLR)at different time points and the mortality and complications in older patients with hip fracture after operation.Methods 217 older patients with hip fracture treated surgically in Shunde Hospital of Southern Medical University were enrolled from January 2013 to December 2017.NLR before operation,at day 1 and day 7 after operation were examined.The mortality and the complications were followed up for 1 year.NLR in complication group and complication-free group,survival group and death group were analyzed.Results There were significant differences in NLR before operation,at day 1 and day 7 after operation between complication group and complication-free group(P<0.01).At day 7 after operation,the area under ROC curve was 0.87,and the best cut-off point was NLR=4.72.Multivariate logistic regression analysis showed that NLR>4.72 at day 7 after operation was an independent risk factor for complications(P<0.001).There were significant differences in NLR before operation,at day 1 and day 7 between survival group and death group(P<0.01).After operation,NLR reduced rapidly in survival group,whereas did not change in death group.The area under ROC curve was 0.79,and the best cut-off point was NLR=4.78.The Kaplan-Meier analysis showed that the survival rate of patients with NLR>4.78 at day 7 after operation was lower(P<0.001).Conclusion In older patients with hip fracture,the NLR>4.72 at day 7 might be a risk factor for postoperative complications,and NLR>4.78 might be related to survival rate.